The
Sestamibi Scan for Hyperparathyroidism (parathyroid problems).

Sestamibi Scanning for Parathyroid Tumors.
The Sestamibi Scan will often show which parathyroid gland is bad,
but it is often wrong. Sestamibi Scans are extremely accurate if done correctly. Most
sestamibi scans are done poorly and give bad information. Be careful
of the sestamibi scan--it can confuse you! Sestamibi scans are
typically incorrect.

.If you like learning by watching videos, then check
our our Video Page!

Sestamibi
scanning is the preferred way to localize diseased parathyroid glands
prior to an operation. HOWEVER, sestamibi scans are wrong at least 50% of
the time, even at
the best places in the world. Be careful folks!

This scan was invented in the early
1990's and now is widely available at essentially every hospital in the
United States. Sestamibi is a small protein which is labeled with the
radio-pharmaceutical technetium-99. This very mild and safe radioactive
agent is injected into the veins of a patient with parathyroid disease (hyperparathyroidism)
and
is absorbed by the overactive parathyroid gland. This is a very important
concept--the parathyroid tumor will collect the radioactive dye. Furthermore,
since normal parathyroid
glands are inactive when there is high calcium in the blood
stream, they do NOT take up the radioactive particles. Therefore, a
sestamibi scan will show the one bad parathyroid tumor and it will NOT show your
normal parathyroid glands. When an x-ray
machine is placed over
the patient's neck an accurate picture will show the overactive gland and
where it is located in your neck. The
picture above and to the right shows a Sestamibi scan for a patient with a
parathyroid tumor in the lower portion of their neck. This
picture is a close-up of a patient's upper chest, neck, and lower face
(the eyes would be just above the top of the picture and the heart would
be just below the lower edge of the picture). The drawing on the
left shows what is happening in this patient. The large parathyroid gland
that is making too much parathyroid hormone (shown with the black arrow)
has become radioactive. This is what is making the bright yellow spot on
the patients sestamibi scan. The other 3 parathyroids are
responding appropriately to the high blood calcium level by "going to
sleep" and not producing any parathyroid hormone (see parathyroid
function). Since the 3 normal parathyroids are NOT producing any
hormone, they do not absorb radioactivity and therefore do not show up on
this scan (in theory). Be careful, however, most scans are wrong. If the
scan is negative, it is wrong 100% (keep reading), if it is positive, it is
wrong about 50% of the time. Too much emphasis is put on this one test. Don't
fall for this trap!

Editor's note from Drs Norman, Politz, and Lopez: Sestamibi scans are usually not done
correctly. Most sestamibi scans
will be read as "negative" because they were not done correctly.
This cannot be over stated. In our opinion, the NUMBER ONE PROBLEM for
patients with parathyroid disease is that their doctor (usually
endocrinologist) has a patient get a sestamibi scan and the scan turns out
negative. The scan is negative because they don't know how to do the scan
well (or the parathyroid tumor is right behind the thyroid gland and so it
can't be seen). The doctor gets confused by the sestamibi scan,
doesn't know what to do, and then begins to question if the patient has the disease... and
then tells the patient... "the scan was negative, let's wait a few
months and test your blood levels again". Or, they will say,
"the scan is negative so we can't send you to a surgeon" (you
don't want this surgeon if they only operate on people with positive
scans). Or, the third thing they will say is "the scan is negative,
let's give you some vitamin D for a few months to see if that makes things
better". That is idiotic. Giving vitamin D for a tumor? Just because
you can't see it? Huh?

Watch this 3-minute video to see
how a negative scan caused this man to delay his operation 6 years
causing him to develop multiple kidney stones, heart disease with a
heart attack, GERD, and severe osteoporosis. He is only 46. The biggest
problem in all of parathyroid disease is the lack of understanding of the role of
the Sestamibi scan. Sestamibi scans have no role in determining if
somebody has a parathyroid tumor. We believe strongly that
endocrinologists should never obtain a sestamibi scan on a patient with
high calcium. This is a test for the surgeon to order. Said differently, Sestamibi scans are
NOT diagnostic scans and should never be used to determine if a
parathyroid tumor is present (we know a parathyroid tumor is present by
the lab values of blood calcium and PTH). If your doctor says "I
think you have a parathyroid problem so we're going to get a scan to make
sure", then you are getting the scan for the wrong reason.

Sestamibi scans should
never be used to
determine who goes to surgery and who does not. When an endocrinologist
orders a sestamibi scan, it delays that patient going to the operating
room by an average of 2.8 years! Do not fall for this trap. A negative scan
does NOT mean you don't have parathyroid disease, it means the scan was
not done with enough clarity and resolution to show your tumor, or very
commonly, the parathyroid tumor is attached to the back side of the
thyroid gland (where it is supposed to be) and you can't see it on the
scan because all you can see is the bigger thyroid. About 80%
of our patients have a negative scan somewhere else... and then have a
positive scan we we do the scan correctly. (Note we will still look at all
four glands because the scan cannot tell if you have more than one tumor!)
About 85% of people who come to our center for surgery had a negative
Sestamibi scan. Please understand that Sestamibi scans are not very
accurate, so be careful of using this inaccurate test to make any
decisions. Also, understand that we TRY for negative scans, because we
would much rather know where the tumor is NOT located--therefore we know
where it must be located. This allows us to perform mini-surgery on 100%
of patients. We do NOT want a positive scan on our patients, we want a
beautifully crisp (not blurry!) true negative scan--this has much more
value than a positive scan!

Dr Norman has two 7-minute videos that discuss all you
need to know about sestamibi scans.

Remember, we know who has a parathyroid problem
(a parathyroid tumor) by blood work--how much calcium is in the blood. If
you have too much calcium in your blood, you need an operation, you do not
need a scan. No other concept on this website is more important. This is
absolutely the one thing that we would have you know. We see at least
1,750
patients every year who are suffering from the symptoms of parathyroid disease
because they had a negative sestamibi scan--that they should never have
had.

Another Sestamibi scan is shown here on the right. We have used the
computer to color enhance the x-ray, thus it is more blue than the other
scan. Once again, you can see that this patient has one "HOT"
spot in their neck corresponding to a parathyroid tumor that is making too
much parathyroid hormone. When performing a MIRP mini parathyroid
operation, the little radioactive probe that the surgeon uses in the
operating room will find
this radioactive tumor quickly. At our center, this tumor would be removed
in less than 5 minutes. Another important thing to remember about
sestamibi scans is this: Even if it is positive, it does not say anything
about the other three parathyroid glands, and at least 15% of people will
have a second bad parathyroid gland. This is why we look at all four
parathyroid glands in almost every patient because the BEST thing the scan
can do is tell what is happening about ONE gland. It says nothing about
the other three glands. The video we
have online shows this exact situation: the scan shows a beautiful single
parathyroid tumor (one tumor only), yet we look at the other 3 glands and
found two normal glands and a second tumor. You CANNOT simply take out the
hot spot parathyroid tumor. If your surgeon is going to operate on you and
take out the hot spot tumor and call it a "mini" parathyroid
operation, then know you have a 15% chance that you will need a second
operation to remove your second tumor because you will not be cured. You
must be careful of the surgeon who is only going to remove the one
hot-spot tumor! Watch the video and
see it for yourself!

Remember, a Sestamibi scan is a VERY safe
procedure. There is NO cross-reactivity for other types of x-ray
dye, so parathyroid patients with allergies to x-ray dye can have
a Sestamibi scan. Also note that the Sestamibi drug used to show
the over-active parathyroid gland is the exact same drug that is
used to perform cardiac stress tests--it is very safe! ALSO, the
type of radioactivity used is the most mild radioactive agent used
in all of medicine. You are in no danger and your family can stay
with you--it is not dangerous to them either (or your doctor!).

Parathyroid surgery and mini parathyroid
surgery uses sestamibi scanning for best cure rates.This
picture shows the Sestamibi camera. The "x-ray" pictures above are obtained from this camera.
The
Sestamibi scan will often display the hyperactive parathyroid gland which is causing
hyperparathyroidism in about 80 percent of all
patients... BUT, when it does show a single hot gland, it is usually
correct. However, it will not tell anything about the other three
glands. When combined with the probe in the operating room (the
MIRP mini parathyroid operation), and examination of the other glands, the cure rate can be over
99%. It takes approximately two hours
for most places to perform a Sestamibi scan. Pictures of the neck and
chest are usually taken immediately after the injection and again 1.5
to 2.0 hours later.

Note: When sestamibi scans are performed at the Norman Parathyroid
Center, it takes only 15 minutes on average to do
a scan. We almost never take more than 20 minutes to do a scan. Sometimes it is
done in only 10 minutes. Why? Because we
do about 13-14 per day... every day. We do about 20% of all the sestamibi
scans in the US every year. We have developed several techniques
that nobody else in the world does, thus our scans are very clean, crisp,
and accurate. Heck, even our patients can read the x-ray correctly about
90% of the time--that's how easy it is. Remember from above, we try very
hard to get good "negative" information. Finding the big tumor
is easy for us, it's finding the three other glands that takes talent and
experience. After more than 17,000 of these operations we know that
showing the parathyroid tumor on the scan is NOT the challenge, the challenge lies in
assessing the other three glands. "True Negative" information
(knowing 100% that there is nothing under the jaw or in the chest) is
absolutely the most important information a scan can tell us. We LOVE
negative scans... a really good quality negative scan is the best thing we
can get. These patients will have a cure rate of 99.9% at our center with
an operation that takes less than 20 minutes. This is what we do all day,
every day.

When discussing mini-parathyroid surgery, most
endocrinologists and surgeons see things two ways: EASY operations which
can be done "minimally invasive" because the scan is positive
and the surgeon knows where the tumor is, and HARD because the scan is
negative and they don't know where the tumor is located--so they will have
to do an exploration to find the tumor. There is a reason why thousands of
people travel to Tampa for their parathyroid operation every year--because
this view of parathyroid surgery is DUMB. Only inexperienced surgeons need
a positive scan for a mini-operation! All parathyroid operations are
minimally invasive for us because we do not use the sestamibi scan for any
decision making. We do the same, mini-parathyroid operation on every
single patient regardless of scan results. If it wasn't easy, we couldn't
do 12 or more per day with a cure rate near 100%, with everybody going
home in an hour or two. Look folks, we can't say this any clearer--it is
not about the scan, it is about the experience of the surgeon. It is not
about the golf clubs, it is the guy holding the golf clubs. Stop
emphasizing the scan! It's not about the scan. Heck, if you come
here--please don't get a scan. We'll do it 15 minutes before your
operation.

On
of the biggest problems with Sestamibi scanning is the variability in scans
from hospital to hospital. Sestamibi scans are not like any other type of
x-ray test. It doesn't actually use x-rays, so the pictures are extremely
dependent upon the skill of the technician. CAT scans, MRIs, and regular
x-rays all are very similar throughout the world. It is easy to do these
x-rays because of the technology used. All these x-rays are done the same
way everywhere and they are all very excellent quality. Because most hospitals and radiology
departments see only a few parathyroid patients per year, they do not get
many opportunities to perform a sestamibi scan. IMPORTANT! There is a
very high correlation between hospitals that do a lot of Sestamibi
scanning (more than 100 per year) and their accuracy. Like other aspects
of treating parathyroid disease, the experience of the doctors involved
makes all the difference! Click
Here for more technical details on how this scan is performed at Tampa
General Hospital at the Norman Parathyroid Center. This group has published
the highest accuracy rates with Sestamibi scanning and are recognized as
world experts at this type of scan. Sadly, some very high-profile
hospitals, universities and clinics have some of the worst scans in the
US. Here is the simple test to see if you have a good scan.... Simply look
at it. If you can pick up your scan, hold it up to the light and see your
head, neck, and chest (it MUST be clean and crisp) then you have a good
scan. You should see the thyroid gland very clearly (looks like a
butterfly). It should not be blurry. If your scan is blurry, then it is
junk. PERIOD. If your scan is blurry and it is read as negative, then refuse to
pay for it. All patients should demand a copy of their sestamibi scan and
look at it. If it looks like a bunch of blurs and blobs, then you have
just wasted your time. Do not let your doctors make any decisions on your
behalf based upon a sestamibi scan. Our scans are crisp and
clear--thus a crisp, clear, in focus negative scan is PERFECT! That's what
we want.

Since
January of 2003 the Norman Parathyroid Center has been collecting
data on sestamibi scans from different hospitals around the US.
Patients (and doctors) send their x-rays to us to have them evaluated. Our
doctors have reviewed over 60,000 sestamibi scans from hundreds of different
hospitals from all 50 states, now averaging about 100 scans per week that
they review. He has found that most scans are worthless because the
radiology tech that did the scan did not know how to do the scan. We
evaluate and score each sestamibi scan and rank it for quality (if you
are one of Dr Norman's patients, he will share with you his score of your
scans). If you come to Tampa for your operation, you will see your scan
and you will be able to see your tumor prior to the operation, and how
important the "negative" information is--which lets us know 100%
that you do not have a second tumor in your chest, or behind your voice
box. The "negative" information (on a clear, crisp scan) is the
most important part of the scan.

The Sestamibi Quality Scoring Scale goes from 1 to 10, with a score of 10 meaning
that all the right things were done and it is a very high quality scan. If they do everything wrong except
your name, they get a score of 1 (meaning you wasted your time and money).

The 10 items scored are: 1) patient name and date correct, 2) correct
dye dose, 3) correct camera height, 4) camera angle from front and both
sides, 5) camera position (should show just a small part of the liver and
heart, not all of it!), 6) camera focus (must not be blurry at all!), 7)
correct columnation (filter), 8) No pin-hole views (bad!!), 9) no iodine
dual-isotope (very bad scans), 10) correct acquisition time.

Look at this table--and then look at your sestamibi scan--it will make
sense to you. Scans that get a score of 3 will show the parathyroid
tumor only 20% of the time (said differently... you have a tumor in
your neck that's about the size of a grape but the scan can't see it
80% of the time because the scan was done incorrectly). If the
sestamibi scan is done a little better and gets a quality score of 5, then
there is a 75% chance it will show your tumor. If you have this scan done
correctly and the scan is a very high quality (getting a score of 9 or 10)
it will show your tumor about 97% of the time. If your scan is blurry and
was not done correctly, it will be negative... it won't show your tumor
80% of the time. LOOK AT YOUR SCAN! Is it blurry?

Score of the Scan

Shows the Tumor

Same Patient Gets Scan Done by Dr
Norman

3

20%

97%

5

75%

97%

9

95%

97%

The average score for 40,000++ scans done throughout the US between
1/2003 and 1/2010 is 4.3. As you can see from the chart above, this
means that about 52% of scans done in the US are NEGATIVE because of the
technician doing the scan--and the protocol that the technician uses. This
is BLURRY negative and worthless... this is not crisp, clean negative
which has tremendous value. Again, you have a tumor but the x-ray does not show it because they did
the scan wrong! Its
not always his/her fault, they read the instructions out of a book and the
instructions are bad. Thus... if your scan is Negative, it does NOT mean
you have 4 bad glands! (extremely important concept!). It means that
you most likely had a very poor quality scan. Over 90% of scans that are
"negative" at some other hospital are positive when done by Dr
Norman's staff. Sound too good to be true? We wish it was not. We wish
everybody had good scans. We can't operate on everybody. We can't scan
everybody. We are trying to teach, but its hard! You--the patient--need to demand excellence. If your scan is blurry, it is junk and you
should demand better! There is nobody out there that makes sure your
x-rays are done correctly... its up to you ! Don't pay for a blurry scan.

IMPORTANT: Now that you
understand the quality issue of sestamibi scans you will be able to
understand the biggest errors that doctors make. If your doctor tells you
any of the following...then they are WRONG:

"Your scan is negative
so you must have 4 bad glands and not just one bad gland."This
is rubbish. Run from this doctor! RUN, RUN, RUN! You are about to be
treated incorrectly!

"Your scan is negative
so we should just wait for a while and see what happens."
This is rubbish. The scan is negative because some technician doesn't
know how to do the scan, or because the parathyroid tumor is attached
to the back side of the thyroid (where it is supposed to be) and you
can't see it because the thyroid is in the way. Scan results should never be used to decide
who gets surgery and who does not. If you have parathyroid disease
then you need to get it fixed. Wait to have a stroke? Wait to get
severe osteoporosis? High blood pressure? Depression? Chronic
fatigue? Memory loss? Wait around so your risk of breast cancer
doubles, and the risk for prostate cancer nearly triples? Wait for what? Geeezzzz... because some
dude can't do a good x-ray? Watch the video above on this page, it
shows a man that had a negative scan so he didn't have surgery... only
to develop bad osteoporosis, kidney stones, GERD, and have a heart
attack from all the calcium in his coronary arteries.

"Your scan is negative
so you can't have mini-surgery."This may or may not
be true--it depends on the surgeon and his/her expertise with
mini-surgery. At our center we perform mini-surgery on ALL
patients, regardless of scan results. If you have a surgeon that uses
the word "explore", then get out and go somewhere else. If
your kids weren't home at midnight on a Friday night you wouldn't
start exploring the entire city looking for them. You would know the
top 3-4 places where they hang out and you would call them and find
them. Watch
a video on this topic by Dr Norman--this 8 minute lecture has some
great teaching points about finding parathyroid glands during an
operation.

If your doctor tells you any of the above, then please print this page and take it to them. Teach them! Remember, our goal
here is to spread the word and educate. Parathyroid disease is extremely
easy to fix if you have the right personnel. Look folks, it is not about
the scan! Scans are way over emphasized by doctors who don't see
hyperparathyroidism patients very often. Please, please, stop worrying
about the scan... most scans are wrong.

One final thought... some of the worst scans done in the
US are done at major universities while some of the best are done at some
walk-in radiology clinics. Do not simply believe that your scan is going
to be a good scan because you are at some famous big university... Demand
to look at the scan. If you can't understand it without anybody explaining
it to you... and it looks like a bunch of blobs, or your head is way out
of focus and is blurry... then your scan is not going to be helpful. It
will confuse everybody..

Demand a copy of your sestamibi scan and look at it
yourself. Make sure it is clear and crisp... no blurry scans! No out of
focus sestamibi scans! Demand accuracy--its your money, your body, and
your health.
If you are coming to our Parathyroid Center to have your operation, do NOT
get a scan before coming. We will not look at it, and we won't use any
information it contains. Don't send your scan to us, we don't want to see
it. It is wrong!

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the world's leading
parathyroid treatment center
performing over 3,100
parathyroid operations annually (average 64 per week). We are part of the national
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